![]() | Member's News | No.51 September 2007 |
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Introduction
The term diabetes mellitus describes metabolic disorder of multiple
etiologies, characterized by chronic hyperglycemia with disturbances
of carbohydrate, fat and protein metabolism resulting from defects in
insulin secretion, insulin action, or both. The effects of diabetes
mellitus include long–term damage, dysfunction and failure of
various organs. There are mainly three types of diabetes: type 1, type
2, and gestational diabetes. The most common form of diabetes is type
2 diabetes. This form of diabetes is most often associated with old
age, obesity, family history, previous history of gestational diabetes
and physical inactivity. About 80 percent of people with type 2 diabetes
are overweight. The disease often leads to blindness, heart and blood
vessel disease, stroke, kidney failure, amputations and nerve damage.
Healthy eating, physical activity and blood glucose testing are the
basic management tools for type 2 diabetes. In addition, many people
with type 2 diabetes require oral medication, insulin, or both to control
their blood glucose levels.
The number of people diagnosed with diabetes has exploded in the past
several decades. In 2000, it was estimated that 151 million persons
worldwide had diabetes. At the current rate of increase, it has been
projected that 221 million persons will be affected by 2010 and 324
million by 2025; most of these cases will be type 2 diabetes (1).
It has been shown that regular physical activity increases insulin
sensitivity and glucose tolerance. Moreover it has been recently shown
that physical activity reduces the risk of type II diabetes. In an African
American population in the United States it was observed that the prevalence
of diabetes increases with the degree of inactivity and obesity. Obesity
has been implicated as a risk factor for Type II diabetes and obesity
is present in about 80% of type II diabetes patients. Body Mass Index
is directly associated with increase risk of Type II diabetes in many
ethnic groups (2).
The prevalence of obesity has reached epidemic levels worldwide, and
the related health risks of excess adiposity are well recognized by
the medical community (3, 4). Specifically, waist circumference (WC)
provides a simple and practical anthropometric measure for assessing
central adiposity (5–9), and an increasing number of studies are
reporting strong associations between WC, visceral adipose tissue, and
obesity-related health risks (10- 18). Obesity and physical inactivity
are well-established risk factors for the development of type 2 diabetes.
It is estimated that for every 1-kg increase in weight, the prevalence
of diabetes increases by 9%. Physical inactivity is associated with
increased insulin resistance and poorer glycemic control independent
of body weight. Physical activity is particularly important for the
prevention and management of type 2 diabetes and its related morbidities.
Epidemiological studies have shown that physical activity reduces the
risk of type 2 diabetes by 30% in the general population (19).
In one of the recent studies done in Nepal by Shrestha and his colleagues
(20), have indicated that diabetes and hypertension are significant
and related public health problems in those aged = 40 years in urban
areas. As more than 80% of the total (approximately 23.02 million) population
in Nepal resides in rural areas, the overall prevalence of diabetes
and hypertension would not be high in the country as a whole, but there
is an increasing trend of urbanisation along with population increase
in the urban areas.
According to the Nepal Diabetes association website out of all population,
prevalence of diabetes in Urban and Rural areas is 14.6% and 2.5% respectively
in the people more than 20 years and above in Nepal. Using either or
both Fasting Plasma Glucose (FPG) and post-glucose 2-hour Plasma Glucose
criteria, the prevalence of diabetes (diagnosed and undiagnosed) in
population over 40 years in urban population in Nepal was 19.07% (21).
The rapid increase in the prevalence of diabetes appears to have been
greatly influenced be lifestyle changes associated with socio-economic
development and urbanisation. The increase in diabetes and obesity in
urban areas of Kathmandu may soon be a greater public health problem
than infectious and/ or inflammatory diseases (22). The primary aim
of this study was to investigate the anthropometric status of diabetic
patients in Kathmandu, cardio-vascular fitness, the socio-economic impact
in the society and the association between various variables for the
diabetic condition. Materials and Methods
The data for this study had been collected from diabetic patients around
Kathmandu Valley. Patients were informed by pamphlets, posters and personal
phone calls. On 17th March, 2007 Free Diabetes Camp was organized for
collecting all the necessary data for this study. The camp was organized
in the National Stadium in Kathmandu. Ross Craft anthropometric equipments
skinfold caliper, small sliding caliper and steel tape (Canada) were
used for measurement of all the anthropometric measurements and Standard
procedures were followed prescribed by International Society for the
Advancement of Kinanthropometry (ISAK). A&D UC-300 Precision Health
Scale (Japan) Strain Gauge set for Altitude and Latitude adjusted weighing
machine was used for measuring body weight (Digital). Body weight was
measured to the nearest 0.1 kg and height to the nearest 0.1 cm using
calibrated scales and stadiometers. BMI was calculated as weight divided
by height squared.
All the anthropometric calculation had been done by using “Life
Size Educational Computer Software” developed by Human Kinetic.
Body fat percent had been calculated by fractionation method (23). For
Cooper test international standard 400 meter track was used and total
distance was measured to the nearest 100 m and then Max VO2 has been
estimated by Phil Henson equation (24). Assistance of medical doctors
was taken for taking interviews with the diabetic patients. Blood Sugar
was analyzed in Hardic Life Style Clinic-Lalitpur. Blood Pressure has
been measured by “Aneroid Sphygmomanometer-Japan". BMI was
calculated as weight in kilograms divided by the square of height in
meters.
In the present study descriptive statistical tools such as mean and
standard deviation were applied to analyze the data. For the comparison
between men and women Students "t" test was applied. Correlation
Matrix has been calculated to find out the relation between different
variables. Results
The primary study aim was to study the anthropometric status of diabetic
patient in Kathmandu, cardio-vascular fitness, socio economic impact
in society and the association between various variable for the diabetic
condition.
Altogether 92 diabetic subjects (59 men and 33 women) attended the
camp and were all under medication (Table 1-3). They came with their
own interest for check-up.
Table 1 - Age, height and weight of diabetic men in Kathmandu![]() Table 2 - Age, Height and weight of diabetic
women in Kathmandu ![]() Table 3 - Average blood pressure, blood sugar, percent body fat and
BMI of diabetic men in Kathmandu S.N. Age (Years) Blood Pressure
Blood Sugar (mg %) % Body Fat BMI
The mean blood pressure of the diabetic patients in Kathmandu has been
observed between 127 to 136 mmHg for SBP and 85 to 88 DBP (Hypertension140/90
mmHg in adults). Since all of the subjects have diabetes and taking
medicines regularly, their average fasting blood sugar has been observed
between 103. 37 mg % (± 4.69) to 118.38 mg % (± 24.45)
for different age groups. It is note worthy to observe that diabetic
people over 60 years were seen with less percent body fat 23.8 % ±
7.67 and less BMI 24.4 (±1.22) than the other age category (Table
3).
Table 4 - Average blood pressure, blood sugar, percent body fat
and BMI of diabetic women in Kathmandu ![]() For the all women subjects, average blood pressure, fasting blood sugar
level , percent body fat and BMI were observed with 129 ±9.68
(SBP) , 88.03 ± 6.61 (DBP) , 119.86 ± 20.28 (mg %), 31.2
(±5.18) and 27.4 (± 3.99) respectively (Table 4). Skinfold Pattern
The skinfold pattern of diabetics of Kathmandu has been studied. The
skinfolds studied in this study are; triceps, sub scapular, biceps,
supraspinale, abdomen and medial calf. The fat folds were found to be
of greater thickness at the trunk region and thinner at the limbs.
Figure 1 - Average skinfold pattern of men and
women diabetics in Kathmandu ![]() The minimum average skinfold value of men was noted at the medial calf
(9 mm ±4.0) biceps (9.2 mm ± 4.1) and the maximum at abdomen
31.1 mm (±10.9) site (Figure 1). Similar characteristics have
been observed in the women diabetics where earlier with higher values
then the men. Apart from subscapular and abdomen skinfolds women were
having greater skinfold thickness at triceps (20.5 mm ± 5.6),
biceps (11.7 mm ±3.8), supraspinale ( 23.1 mm ± 7.5) and
medial calf (16.4 mm ±5.8) than the men counterparts. Somatotype of Diabetic Patients in Kathmandu ![]() Somatotype is the quantification of the present shape of the human
body. It is expressed in a three number rating representing endomorphy
(the relative adiposity of a physique), mesomorphy (the relative musculo-skeletal
robustness of a physique) and ectomorphy (the relative linearity or
slenderness of a physique) respectively and always in the same order.
Table 5 - Somatotype of diabetic patients of
Kathmandu
n Endomorph Mesomorph Ectomorph ![]() Diabetes patients in Kathmandu are generally possessed with high rating
in endomorph rating. Their average rating is 6.28 (± 1.50) and
7.01 (± 1.37) for men and women respectively (Table 5). In Mesomorph
they were observed with moderate ratings with 4.94 (±1.48) and
3.95 (±1.17) for men and women respectively. In Ectomorph they
were observed with very low ratings 1.30 (±1.07) and 0.56 (±0.71).
In general Diabetics in Kathmandu can be categories as Mesomorphic endomorph,
where endomorphy is dominant. Cooper Test Performances and Maximum Oxygen Capacity ![]() Fitness can be measured by the volume of oxygen one can consume while
exercising at one’s maximum capacity. VO2 max is the maximum amount
of oxygen in milliliters, one can use in one minute per kilogram of
body weight.
Table 6 - Cooper test and maximum oxygen capacity
of diabetics in Kathmandu ![]() There is a trend of gradual decrease in the cooper test performance
(distance covered in 12 minutes) from 1354 meters (± 110.8) for
the age group 30 to 39.99 to over 60 years group (1172.3 m ±
83.02) in the men section and similar trend can be observed on the women’s
groups also (Table 6). As the distance decreases it is natural that
corresponding maximum oxygen capacity do shows a similar trend. Conclusion
can be drawn that diabetics in Kathmandu have very low cardiovascular
fitness according to latest cooper cardio respiratory fitness test norms
(25). Diabetes Background, Medication, Women’s Attitude and Physical
Activity
Participants of the diabetes camp were briefly interviewed about their
Diabetes background, medication, women’s attitude and physical
activity. Altogether 19 questions were asked to them. According to men
diabetic respondents 22 % of them were suffering this condition less
then 5 years, 55.93 % were living between 5 to 10 years and 22 % men
were living more than 10 year with this diabetic condition. Out of 33
women respondents, more than 54 % are living with diabetic condition
more then 5 years and less than 10 years, 30.3 % respondents had expressed
that they are living with more than 10 years and 15.15 percent of them
were living less than 5 years.
Along with diabetes condition, 44.07 % of the men and 36.36 % of the
women had expressed with blood pressure problem, 13.56 % of the men
and 21.21 % of the women have Osteoarthritis, 5% men have heart problem
and 6.06 % women have COPD. Apart from diabetes 37.3 percent men and
33.33 percent women said they have no other Health problems. Only 32.2
% men and 39.4 % women had revealed that their parents are diabetic.
Among diabetic patients who visited the camp, 50.6 % men and only 6.06
% women did smoke. Among these participants, 69.5 % men do drink alcohol
but on the contrary 87.9 percent women does not. Medication Cost
Majority of the diabetic patients do blood sugar test once in every
two months (40.68 % of men and 45.45 % of women). Around 31 % of the
men and the women test their blood each month and remaining rest does
it every three months. Per blood sugar test, majority of the men (50.85
%) and the women (66.67%) respondents are paying more than 50 Rupees
(1US$=65 Nepalese Rupees) and the rest of them are paying less than
50 Nepalese Rupees.
The second step of the medication procedure is to visit the doctors
to show their blood test report. 49.15 % the men and 51.52 % the women
revealed that doctors are charging NRs 200 per visit. Other halves of
the patients are paying more than NRs 200 per doctor visit. Since they
are taking medicine regularly, 59.32 % of the men and 69.7 % of the
women are spending NRs 500 per month for the medicine. The Rest of the
patients do spend more than NRs1000.00 per month for medicine.
Figure 2 - Monthly expenses for medication from
their total income-men
![]()
Most of the women who came to the camp are housewives. They do not have
personal income and expenses are bared by their husbands. Among men,
96.6 % of them bear all these expenses by themselves and only 30.3 %
of the women do bear these costs themselves. The cost for medication
is big burden for the Nepalese people. According to the camp participants,
69.49 % of the men and 72.7 % of the women are spending 10 percent of
their total income for the management of diabetic medications. 22 %
of the men and 21.2 % of the women spent 5 % of their income for the
medication. The rest of the diabetic patients spend 15 % or more for
the medication form their total income.
In the Nepalese society there is a custom of too much feeding with
food rich in calories and fat after delivery of a child. Apart from
this these women were not allowed to work physically inside or outside
their home. So, women were asked to give their opinion on excess feeding
after delivery. 51.1 % of the women had opinioned that excess feeding
to women after delivery is good for their health. The Rest of the others
said vice-versa. On the other side, 57.6% of the women had opinioned
that doing exercise or household works are not good for the women after
the delivery of a child.
There is no doubt that exercise is very important in managing diabetes.
Combining diet, exercise and medicine will help control one’s
body weight and blood glucose level. Diabetic patients in the camp were
asked for the details of their exercise habits. More than 50 percent
respondents (55.03 % men and 51.52 %women) do have exercise habit. The
others do not do any kind of exercises.
Among the person with exercise habit, 51.5 % of the men and 70.6 %
of the women do exercise for 60 minutes and 30 minutes respectively
per day. Men diabetic patients do walking (78.8%), running (15.15%)
and badminton (6 %) as the main choices during activities. On the other
side all the women who did exercise (51.5 %) did only walking.
Figure 3 - Do the doctors explain properly for exercise? ![]() As mentioned before, after blood test the diabetic patients do go to
visit medical doctors for the medicine prescription and some other advices
concerning food and exercises. Around 45 % out of all the respondents
said doctors do not explain properly for exercises programs. Around
two third of the diabetic patients expressed that they did not have
disruptive sleep at night. 47.46 % of the men and one third of the women
do sleep 7 hours and 6 hours respectively at night. 5 % of the men and
9.1% of the women have only 4 hours of sleep at night.
Table 7 - Comparisons between men and
women on different variables
![]() Students “t” Test has been applied for the comparison between
men and women diabetics on different anthropometrical and other variables.
There has been no significant difference between men and women on age,
blood pressure, sugar level, sub-scapular, supraspinale, abdomen skinfolds,
hip circumference and the sum of six skinfolds. Women are nearly 10
cm shorter in height then the men counterparts and the difference is
significant. On endomorphy and triceps skinfold women diabetic have
higher values then the males.
It is natural that females do possess more % of fat in their body than
their male counterparts. Women diabetics have 31.2 % body fat in compare
to men with 26.55 % and the difference is highly significant. Others
variables like mesomorphy, ectomotphy, waist circumference, Cooper test
and max Vo2, the women have significantly lower values than the men.
In BMI, biceps and medial calf skinfolds women have significantly greater
average values than the male counterparts. Correlation Matrix of Different Variables
Various correlations have been calculated among different anthropometrical
and other variables.
Table 8 - Correlation matrixes of Kathmandu diabetics
on different variables - Men
![]() It has been observed that body weight had
shown a fair correlation with % body fat (0.74), supraspinale skinfold
(0.72), abdomen skinfold (0.73), and higher association on BMI (0.82),
Waist (0.81) and Hip circumference (0.85) a men diabetics in Kathmandu.
In the same way percent body fat had shown strong correlation with endomorphy
(0.97), supraspinale (0.81). Body Mass Index (0.71) and abdomen skinfold
(0.70) have fair association with % body fat. Endomorphy had shown higher
association with supraspinale skinfold (0.88) and fair association with
abdomen skinfold (0.72). Mesomorphy also had fair association with BMI
(0.76).
Table 9 - Correlation matrixes of Kathmandu diabetics
on different variables -Women
![]() Similarly, women diabetics had shown strong and fair associations among
different variables. It has been observed that body weight had shown
a high correlation with BMI (0.83), waist circumference (0.79), and
a fair association with hip circumference (0.70). Percent Body Fat had
shown strong association with endomorphy (0.97), supraspinale skinfold
(0.88) and fair association with BMI (0.71), abdomen skinfold (0.81).
Endomorphy had shown higher association with supraspinale (0.88) and
abdomen skinfold (0.77). Mesomorphy also had fair association with BMI
(0.76). Discussion
The present surveys study is an effort to describe the prevalence of
anthropometric status, socio-economical and fitness related factors
of diabetics in Kathmandu. The included population may consider as representative
of middle class urban population in Kathmandu valley. So the obtained
results may not be readily applied to the rest of the Nepalese population,
for instance countryside populations, or populations from other regions
of the country.
In the present investigation, the most striking characteristics of
age groups 30 - 39.99 and 40 - 49.99 men are having more blood pressure,
sugar % body fat and BMI is found to be higher that older age groups.
The main reason behind this might be using car and motor bikes of this
age group. Taking into the consideration to BMI and % body fat, the
studied population had a higher prevalence of being overweight and obese.
The prevalence of hypertension in those with type 2 diabetes rises from
40% among those aged 45 years to 60% in those aged 75 years. Hypertension
in diabetes further increases the already increased risk of cardiovascular
disease, retinopathy, and microalbuminuria (26).
The use of skinfold and anthropometric techniques on diabetics have
been largely directed towards estimating the amount of subcutaneous
fat in the body. Diabetics in Kathmandu are having enormous fat in their
body. Women diabetics are having more skinfolds thickness than the men
counterparts. Usually most of the women stay home doing house hold works
whereas men goes outdoor. Definitely because of this reason men are
physically more active than women in Kathmandu. Because of these reason
high rating in endomorphy is natural. In San Diego, California somatotyped
47 Type II diabetic women aged 30 to 72 (> 140 mg/dl) by the Heath-Carter
anthropometric method. The mean somatotype was 9.5 – 6 –
1, with 91.5 % dominating in endomorphy and 85 % meso-endomorphs (27).
Endomorphs are large framed, heavy-set individuals with relatively low
metabolic rates who find it extremely difficult to lose adipose tissue.
They require fewer calories to maintain lean tissue and have a need
for more rest days since the breakdown and rebuilding of muscle tissue
does not occur as readily as for the other two types of somatotypes
(28).
Along with diabetes condition, prevalence of blood pressure and osteoarthritis
are seen in Kathmandu. Marginal percentage diabetics have heart problem
and COPD. Genetic relation is prevailed with 32.2 and 39.4 percent for
men women respectively. 50.6 % men and only 6.06 % women diabetics do
have smoking habit. Among these participants, 69.5 % men do drink alcohol
but on the contrary 87.9 % women does not.
Medication for the management of diabetes is becoming big burden for
poor people in Kathmandu. Nearly 70 percent of Kathmanduites Diabetics
are spending more than 10 percent of their total income for the management
diabetes. Kathmanduites are paying money for every step from blood test
to purchase of prescribed medicine. Very few can get reimbursement from
their office or insurance companies. Social welfare or health insurance
is in infant stage in Nepal. Medical treatment is a big business in
Nepal and the government is helpless for the welfare of people.
51.1 % of the women had opinioned that excess feeding to women after
delivery is good for their health. It’s very difficult to change
their social custom and people’s mentality. Lots of Nepalese people
still believe social rituals and forced to follow within society. Bhattarai
and Singh in their study of 200 of urban Kathmandu have found body weight
of 61.3 kg ± 4.9, 67.2 kg ± 6.3 and 63.4 ± 6.4
before the first pregnancy and 6 months and 1 year after delivery respectively.
Similarly, the mean and ± SD of body mass index were 21.3 ±
1.8, 27.9 ± 2.5 and 26.7 ± 2.8 respectively for the same
sample (29).
More than 50 percent respondents do have exercise habits. Around 45
percent out of all the respondents say doctors do not explain properly
for exercises. Doctors involved in treatment of diabetics need to acquire
more knowledge for physical exercise and convince their clients more
effectively. A greater reduction in cardiovascular disease risk would
be anticipated by increasing either the duration or intensity of physical
activity. Data from most weight loss studies suggest that 60–75
min of moderate intensity activity (e.g. walking) or 35 min of vigorous
activity (e.g. jogging) daily is needed to maintain long-term weight
loss (30).
They have shown very low cardiovascular fitness with 25.9 ml/kg/min
(± 1.76) for men and 24.01 ml/kg/min (± 1.76) for women.
The reason behind this condition is that the women diabetics have more
body fat % than the men. Londeree in his study on long distance runners
had concluded that each one-percentage increase in percentage in fat,
the Vo2 max decrease slightly more than one percentage (31). Christou
et al. (32) observed that waist circumference, BMI, and total body fat
were better predictors of insulin sensitivity, assessed with an intravenous
glucose tolerance test, than VO2max in 135 men aged 20–79. Body
fat distribution is also an important risk factor for obesity-related
diseases. Excess abdominal fat (also known as central or upper-body
fat) is associated with an increased risk of cardiometabolic disease.
However, precise measurement of abdominal fat content requires the use
of expensive radiological imaging techniques. Therefore, waist circumference
(WC) is often used as a surrogate marker of abdominal fat mass, because
WC correlates with abdominal fat mass (subcutaneous and intra-abdominal)
and is associated with cardiometabolic disease risk (6). Men and women
who have waist circumferences greater than 40 inches (102 cm) and 35
inches (88 cm), respectively, are considered to be at increased risk
for cardiometabolic disease (33).
There have been various stronger correlations among different variable
of diabetics of Kathmanduites. Percent body fat had shown strong correlation
with endomorphy, supraspinale. Body Mass Index and abdomen skinfold
have fair association with % body fat in men. Body weight of women diabetics
had shown high correlation with BMI, waist circumference. Percent body
fat had shown strong association with endomorphy, supraspinale skinfold
and fair association with BMI, abdomen skinfold. Endomorphy had shown
higher association with supraspinale and abdomen skinfold. Conclusions
Women diabetics have 31.2 percent body fat in compare to men (26.55%)
and the difference is highly significant. On the basis of BMI and %
body fat, the studied diabetics of Kathmandu population had a higher
prevalence of overweight and obese. Women have greater skinfold thickness
at triceps (20.5 mm ± 5.6), biceps (11.7 mm ±3.8), supraspinale
(23.1 mm ± 7.5) and medial calf (16.4 mm ±5.8) in compare
to men counterparts.
Diabetics in Kathmandu are generally possessed with high rating in
endomorph rating with average rating of 6.28 (± 1.50) and 7.01
(± 1.37) for men and women respectively. In mesomorph they were
observed with moderate ratings with 4.94 (±1.48) and 3.95 (±1.17)
for the men and the women respectively.
Gradual decrease in cooper test performance has been observed from
1354 meters (± 110.8) for the age group 30 to 39.99 to over 60
years group (1172.3 m ± 83.02) in both men and women sections
resulting very low cardiovascular fitness according to latest cooper
cardio respiratory fitness test norms.
Prevalence of high blood pressure and osteoarthritis are seen diabetics
in Kathmandu. Genetic relation is prevailed with 32.2 and 39.4 % for
men and women respectively. 50.6 of the men and only 6.06 of the women
diabetics do smoking habit. Among these participants, 69.5 % of men
do drink alcohol but on the contrary 87.9 % of the women do not.
57.6 % of the women had opinioned that doing exercise or household
works are not good for the women after delivery a child. More than 50
percent respondents (55.03 of the men % and 51.52 % of the women) do
have exercise habit.
Approximately 45 % out of all the respondents say doctors do not explain
properly for exercises. Doctors involved in treatment of diabetics need
to acquire more knowledge for physical exercise and convince their clients
more effectively.
On variables like mesomorphy, ectomotphy, waist circumference, cooper
test and max Vo2, women have less average values than the men and the
differences are highly significant. Around two third of the diabetic
patients expressed that they do not have disruptive sleep at night.
Body weight had shown higher correlation with BMI, waist and hip circumference
for men diabetics in Kathmandu. On the other side percent body fat had
shown strong correlation with endomorphy, supraspinale. BMI and abdomen
skinfold have fair association with % body fat.
Body weight of the women diabetics had shown high correlation with
BMI, waist circumference, and fair association with hip circumference.
Percent body fat had shown strong association with endomorphy and supraspinale
skinfold. Recommendations
Acknowledgement
The investigator extends thanks to all the subjects for their kind
cooperation and selfless support during the course of research. From
Nepal, the investigator is grateful to National Sports Council and Nepal
Athletics Association for their kind cooperation for providing office
and stadium track for the conducting Diabetics camp.
The investigator would remain thankful to Bimala Joshi (Amatya), Prakash
Lal Shrestha, Chhitij Arun Shrestha, Prabin Tuladhar, Rajendra Tuladhar,
Bhairab Shahi, Bulal Maharjan, Dhani R. Chaudhari, Dhurba Khanal, Shanta
Bahadur Shrestha, Pradeep Maharjan, Prakash Maharjan, Bishnu Hari Dahal,
Kopil Kumar Thapa, Dr. Pawan Shrestha and Dr. Om Singh for their help
and cooperation while colleting data during the camp.
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Diwakar Lal Amatya
President-National Association for Sports Science Health and Fitness 16/1, Nakabahil, Lalitpur, Nepal Emails: dlamatya@ntc.net.np, amatyadiwakar@yahoo.com Prof. Marina Goris Department of Kinesiology Dept. Biomedische Kinesiologie Heverlee, Belgium Email: marina.goris@faber.kuleuven.be ![]() http://www.icsspe.org/portal/index.php?w=1&z=5 |